Dynamic Duo: Antibiotics and Probiotics

Post on Dec 10, 2012 by Jennifer Huber from QUEST Northern California

Antibiotics work by killing bacteria or by stopping bacteria from multiplying. Each type of antibiotics affects different bacteria in different ways, although broad-spectrum antibiotics are used to treat a wide range of infections. Antibiotics quickly make you feel better because the drug kills the majority of the targeted bacteria very quickly.

However antibiotics also kill beneficial bacteria and induce negative side effects — most commonly diarrhea, upset stomach, and vaginal yeast infection. For instance, antibiotics cause about one out of three people to get diarrhea by disrupting the balance of the intestinal flora, a collection of bacteria and other microorganisms in the digestive tract. This can result in an overgrowth of the Clostridium difficile bacteria that causes diarrhea. Similarly, antibiotics can disrupt the vaginal flora and cause an overgrowth of Candidayeasts to cause a yeast infection.

Probiotics are live bacteria, yeasts and other microbes intended to maintain or restore the supply of beneficial bacteria in the body, particularly the stomach and intestines. Probiotics are found naturally in certain foods, including yogurt, aged cheeses, kefir, miso, tempeh, and fermented cabbage. Dietary supplements are another common source of probiotics.

Although probiotics have been widely promoted as a way to keep your body in balance, scientific evidence for these claims have been weakened by the small size of most research studies. However, the use of probiotics to reduce antibiotic-induced side effects is now becoming more widely accepted by the medical profession.

In a recent study  published in the Journal of the American Medical Association supports taking probiotics with antibiotics. A team of researchers from southern California combined and analyzed the results of 63 randomized controlled trials of probiotics for the prevention or treatment of antibiotic-associated diarrhea. The 11811 men and women included in this large combined study took a placebo or probiotics supplement along with their antibiotics. The people who took the probiotics were 42% less likely to develop diarrhea than those taking the placebo. This pooled evidence strongly suggests that probiotics can help populations of beneficial bacteria recover and more quickly restore balance in the intestines.

However, further research is needed to determine which probiotics are the most effective at preventing and treating antibiotic-associated side effects, as well as determine the optimal dose of the probiotics. Research is also needed to identify which antibiotics are most likely to induce adverse effects. Hopefully these further studies are underway.

Of course it is also important to limit your use of antibiotics, using them only for bacterial infections when necessary. Common cold and flu viruses don’t respond to antibiotics anyway.

Science

Rampant use of antibiotics making pneumonia a killer

Payal Gwalani, TNN | Nov 6, 2012,

NAGPUR: More incidences of a disease generally equip doctors to manage it better. However, it is the opposite in case of pneumonia, especially the one acquired at the hospitals. Doctors blame indiscriminate use of antibiotics, which has made the pathogens causing this disease more resistant, for making this condition a potentially fatal one.

These were among the many topics discussed during a symposium and clinical meeting of Academy of Medical Sciences on pneumonia held ahead of the World Pneumonia  Day that falls on November 9. While Dr PP Joshi and Dr Amol Sagdeo presented some interesting cases, Dr Ravindra Sarnaik, Dr Sanjeev Mehta, Dr Shrinivas Samavedam, Dr Yagnesh Thakkar and Dr Nainesh Patel  spoke about the various aspects of managing the disease.

President of AMS Dr Rajan Barokar said other than the known viral originated pneumonia, bacterial and fungal pneumonia is increasingly being reported. "Managing pneumonia and its higher form - acute respiratory distress syndrome (ARDS) - is a challenge for the critical care team," he said. Agreeing with this, Dr Chandrashekhar Cham, secretary of AMS, added that secondary infections of this kind acquired at hospitals are emerging as big killers in ICUs. Dr Sarnaik said with many ailments coexisting, the treatment gets more complicated and longer.

Dr Samavedam informed that 40 per cent patients visiting OPD have respiratory infections while 15 per cent have pneumonia. "A lot of cases do not even get reported as they occur at places where medical services may not be well developed," he said. He warned that parents must be cautious when children have fever that persists for more than two days or is acquired after returning from a holiday or after consuming outside food.

Dr Mehta gave the example of France where government rewards the doctors who give least number of antibiotics and make the patients aware about their misuse. "The pathogens that cause hospital acquired infections are immune to many of the common antibiotics. This has given rise to stronger microbes that are lurking around the hospital. Instead of trying different medications, doctors must send the cultures for laboratory tests to decide the course of drugs," said Dr Thakkar.

Dr Patel spoke of a newly emerging form of pneumonia that has resulted from high resistance among the pathogens called health care associated infections. "This means that the disease, even if acquired outside the hospital or in the community, becomes difficult to treat due to resistance from the organisms causing them," he explained.

Dr SK Deshpande blamed lack of hygiene and overcrowded living spaces for this phenomenon. "Urban slums and a general apathy towards cleanliness have made this situation so bad," he said.

Times of India

Complications of cardiac implants: handling device infections.

2012

Nof E, Epstein LM.

Source

Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.

Abstract

Managing patients with cardiac implantable electrophysiological devices (CIED) infections can be challenging. The first step should be prevention, which involves patient selection, timing of implantation, and the procedure itself. After implantation, a high degree of suspicion should be applied in order to correctly diagnose patients with infected implanted devices. It is necessary to recognize that patients can present with a wide variety of signs and symptoms. Once diagnosed, the next step is determining if it is a local pocket infection or system infection. In almost every patient, in addition to antibiotics, complete removal of ALL hardware is required. Transvenous lead extraction is now safe and effective, but should only be performed at experienced centres with a practiced extraction team, all possible needed equipment, and cardiothoracic surgical backup. After extraction, the indication for CIED therapy should be re-evaluated to determine re-implantation is warranted. Timing of re-implantation depends on a variety of factors such as type of infection or valvular involvement and should be made in concordance with an infectious disease specialist. This review is aimed at introducing the steps needed to manage patients with infected cardiac devices.

PubMed

Europe's response to the problem of antibiotic shortage

Europe's response to the problem of antibiotic shortage

Feb 25, 2912

Brussels - The issues of antibiotic shortage and growing resistance of many microorganisms to antibiotics is a significant global health issue. Strategies to tackle this issue have varied worldwide.

European Union wide data published by the European Centre for Disease Prevention and Control (ECDC) on antibiotic resistance has shown that resistance to last-line antibiotics is increasing in Europe (last-line refers to the fact that many bacteria are now resistant to the older generation of antibacterials; last-line refers to the last set of effective antibiotics available). Resistance by pathogens which frequently cause pneumonia and urinary tract infections in hospitals is increasing across the EU and is now established in several countries. These are the 'super bugs' (or multidrug resistant bacteria).

Many bacteria have become resistant to antibiotics through the widespread (some would say overuse) of antibiotics. It is well established that exposing bacteria to the right antibiotics kills most of them. However, the antibiotics course often leaves a few mutants behind that happen to resist the drug better than the rest. These mutants go on to multiply, and, over the course of many years and between many people, eventually the whole strain evolves resistance. Scientists have got round this by developing new generations of antibiotics. The problem now facing the world is that the latest generation may be the last, at least it is becoming increasingly difficult to formulate new antibiotics.

With Europe, the European Centre for Disease Prevention and Control (ECDC) has recently announced a strategy to tackle this issue.

According to the ECDC director, Dr. Marc Sprenger:

"The goal of this Europe-wide health initiative is to support national campaigns on prudent use of antibiotics. Overuse of antibiotics, both in hospitals and in the community, is one of the major drivers of drug resistance in bacteria. ECDC collects EU-wide data on these resistant bacteria, mostly from laboratories testing blood samples taken in hospitals. New data, released by ECDC today, shows that antibiotic resistance is increasing across the EU."

This has lead to a five year plan to address antibiotic issues. The key steps of the plan, displayed on the European Commission website, are:

a) Improve awareness raising on the appropriate use of antimicrobials

b) Strengthen EU law on veterinary medicines and on medicated feed

c) Introduce recommendations for prudent use of antimicrobials in veterinary medicine

d) Strengthen infection prevention and control in hospitals, clinics, etc.

e) Introduce legal tools to tighten prevention and control of infections in animals in the new EU Animal Health Law

f) Promote unprecedented collaboration to bring new antimicrobials to patients

g) Promote efforts to analyse the need for new antibiotics in veterinary medicine

h) Develop and/or strengthen multilateral and bilateral commitments for the prevention and control of AMR

i) Strengthen surveillance systems on AMR and antimicrobial consumption in human medicines

j) Strengthen surveillance systems on AMR and antimicrobial consumption in animal medicines

k) Reinforce and co-ordinate research

l) Improve communication on AMR to the public.

The purpose of the ECDC's focused is summarized in a press release:

"For a large part, antibiotic resistance is being driven by misuse of antibiotics in humans and animals. According to the latest data released by ESAC (European Surveillance of Antimicrobial Consumption), the vast majority of human consumption of antibiotics occurs in the community. Resistance to last-line antibiotics like the carbapenems, however, cannot be explained only by the use of antibiotics outside hospitals. Studies show that 50% of all antibiotic use in hospitals can be inappropriate. Prudent use of antibiotics is paramount to prevent and control resistant bacteria. Additionally, compliance with good hand hygiene by healthcare workers is the most effective way to prevent the spread of infections in hospitals. Finally, there is a particular lack of new antibiotics with new targets of mechanisms of action, in particular against carbapenem-resistant Gram-negative bacteria."

Read more: Digital Journal

How Using Antibiotics in Animal Feed Creates Superbugs

How Using Antibiotics in Animal Feed Creates Superbugs

Many livestock groups say there's no evidence that antibiotics in livestock feed have caused a human health problem, but researchers beg to differ.

Researchers have nailed down something scientists, government officials and agribusiness proponents have argued about for years: whether antibiotics in livestock feed give rise to antibiotic-resistant germs that can threaten humans.

A study in the journal mBio, published by the American Society for Microbiology, shows how an antibiotic-susceptible staph germ passed from humans into pigs, where it became resistant to the antibiotics tetracycline and methicillin. And then the antibiotic-resistant staph learned to jump back into humans.

"It's like watching the birth of a superbug," says Lance Price of the Translational Genomics Research Institute, or TGen, in Flagstaff, Ariz.

Price and colleagues in 19 countries did whole-genome analysis on a staph strain called CC398 and 88 closely related variations. CC398 is a so-called MRSA, or methicillin-resistant Staphylococcus aureus, that emerged within the past decade in pigs and has since spread widely in cattle and poultry as well as pigs.

The genetic analysis allowed the study authors to trace the lineage of the livestock bug back to its antibiotic-susceptible human ancestors. Price says it shows beyond a doubt that the animal bacterium jumped back into humans with close exposure to livestock.

This "pig MRSA" has been detected in nearly half of all meat sampled in U.S. commerce, according to the American Society for Microbiology. Most staph found in meat can be eliminated by cooking food well, but it can still pose a risk to consumers if handled unsafely or if it cross-contaminates with other things in the kitchen.

Price told The Salt that the new resistant human bug appears to be spreading beyond people with direct exposure to livestock.

"Initially we could always trace it back to livestock exposure," Price says. "But now we are starting to see cases of resistant strains that we can't trace back. So we think it may be changing gears, so to speak, and gaining the capacity to be passed from person to person."

Price says the new data provide an early warning of what might become a major public health problem.

"We're seeing this one coming," he says. "The question is how often will this occur in the future if we don't start controlling antibiotic use?"

So far, the proportion of human MRSA infections due to this livestock-derived strain is small. But in some areas of the Netherlands, it's causing as many as 1 in 4 human MRSA cases — suggesting that it has the potential to spread extensively.

Paul Keim, another study author, says the report shows that "our inappropriate use of antibiotics ... is now coming back to haunt us." He says the solution is clear — banning antibiotics in livestock feed, as the European Union has done.

Most antibiotics sold in the U.S. go to animals, mostly in their feed, where they act as a growth promoter and damp down infection outbreaks in large feedlots.

Many livestock groups say there's no evidence that using antibiotics in livestock feed creates a human health problem.

"Most informed scientists and public health professionals acknowledge that the problem of antibiotic resistance in humans is overwhelmingly an issue related to human antibiotic use," the American Meat Institute says.

The new report adds fuel to the long-running debate about antibiotic use for livestock, and the government's responsibility to regulate it. In December, the FDA withdrew a 1977 proposal to remove approvals for two antibiotics, penicillins and tetracyclines, used in livestock and poultry feed. It said it would focus instead on "voluntary reform" by the meat industry to limit use.

Then in a partial reversal in January, the agency said it would ban one class of antibiotics called cephalosporins from animal feed.

NPR

Colistin: An overview

Colistin / Hydrocortisone / Neomycin

Generic Name: Colistin/Hydrocortisone/Neomycin (koe-LIS-tin/hye-droe-KOR-ti-sone/nee-oh-MYE-sin)
Brand Name: Coly-Mycin S Otic

Colistin/Hydrocortisone/Neomycin is used for:

Treating infections of the ear caused by certain bacteria. It may also be used for other conditions as determined by your doctor.

Colistin/Hydrocortisone/Neomycin is a combination of 2 antibiotics and a corticosteroid. The antibiotics work by killing sensitive bacteria. The corticosteroid reduces inflammation.

Contraindications for use - Do Not Use

• you are allergic to any ingredient in Colistin/Hydrocortisone/Neomycin , to other aminoglycosides (eg, gentamicin), or to other corticosteroids (eg, prednisone)
• you have a viral infection of the ear (eg, herpes simplex, chickenpox, shingles)
• you have a perforated ear drum

Contact your doctor or health care provider right away if any of these apply to you.

Before using Colistin/Hydrocortisone/Neomycin

Some medical conditions may interact with Colistin/Hydrocortisone/Neomycin . Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines, foods, or other substances
• if you have the blood disease porphyria

Some MEDICINES MAY INTERACT with Colistin/Hydrocortisone/Neomycin . Because little, if any, of Colistin/Hydrocortisone/Neomycin is absorbed into the blood, the risk of it interacting with another medicine is low.

Ask your health care provider if Colistin/Hydrocortisone/Neomycin may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

Drugs.com

Colistin: An overview

INTRODUCTION

— Colistin (also called polymyxin E) belongs to the polymyxin group of antibiotics [1]. It was first isolated in Japan in 1949 from Bacillus polymyxa var. colistinus, and became available for clinical use in 1959 [2,3]. Colistin was given as an intramuscular injection for the treatment of Gram negative infections but fell out of favor after aminoglycosides became available because of its significant side effects. It was later used as topical therapy as part of selective digestive tract decontamination and is still used in aerosolized form for patients with cystic fibrosis.

More recently, a number of centers around the world have used colistin intravenously for otherwise panresistant nosocomial infections, especially those due to Pseudomonas and Acinetobacter spp [4-8].

The spectrum of activity, mechanisms of action and resistance, pharmacokinetics, interactions with other drugs, and adverse effects of colistin will be reviewed here. The clinical settings in which colistin may be used are discussed separately in the appropriate topic reviews.

MECHANISM OF ACTION

— Colistin is a bactericidal drug that binds to lipopolysaccharides and phospholipids in the outer cell membrane of gram-negative bacteria. It competitively displaces divalent cations from the phosphate groups of membrane lipids, which leads to disruption of the outer cell membrane, leakage of intracellular contents, and bacterial death [3,9,10].

In addition to its bactericidal effect, colistin can bind and neutralize lipopolysaccharide (LPS) and prevent the pathophysiologic effects of endotoxin in the circulation [11,12].

(Excerpt - UpToDate)

Pediatric fingertip injuries: do prophylactic antibiotics alter infection rates?

Pediatric fingertip injuries: do prophylactic antibiotics alter infection rates?

Pediatr Emerg Care. 2008 Mar

Altergott C, Garcia FJ, Nager AL.
Department of Pediatrics, Division of Emergency Medicine, Childrens Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA 90027, USA. caltergott@chla.usc.edu

STUDY OBJECTIVE: Fingertip injuries are common in the pediatric population. Considerable controversy exists as to whether prophylactic antibiotics are necessary after repair of these injuries. Our goal was to compare the rate of bacterial infections among subgroups treated with and without prophylactic antibiotics. The study hypothesis was that infection rates were similar in the 2 groups.

METHODS: This was a prospective randomized control trial of pediatric patients presenting to an urban children's hospital with trauma to the distal fingertip, requiring repair. Patients were randomized to 2 groups: group 1 received no antibiotics, and group 2 received antibiotics (cephalexin). Repairs were performed in a standardized fashion, and all patients were reevaluated in the same emergency department in 48 hours and again by phone 7 days after repair. The primary outcome measure was the rate of infection at 7 days after repair.

RESULTS: One hundred forty-six patients were initially enrolled in the study, 11 patients were withdrawn before study completion, 69 subjects were randomized to the no-antibiotic group, and 66 subjects were randomized to the antibiotic group. There was 1 infection in each group at 7 days after repair. The infection rate was 1.45% (95% confidence interval, 0.04%-7.81%) for the no-antibiotic group and was 1.52% (95% confidence interval, 0.04%-8.16%) for the antibiotic group, not statistically significant (P = 1.00).

CONCLUSIONS: This study suggests that routine prophylactic antibiotics do not reduce the rate of infection after repair of distal fingertip injuries.

Lippincott, Williams & Wilkins

The effect of the timing of antibiotics and surgical treatment on infection rates in open long-bone fractures: A 9-year prospective study from a distr

The effect of the timing of antibiotics and surgical treatment on infection rates in open long-bone fractures: A 9-year prospective study from a district general hospital.

Injury. 2007 Jun 19
Al-Arabi YB, Nader M, Hamidian-Jahromi AR, Woods DA.
The Great Western Hospital, Marlborough Road, Swindon SN3 6BB, United Kingdom.

AIMS: To determine whether a delay of greater than 6h from injury to initial surgical debridement and the timing of antibiotic administration affect infection rates in open long-bone fractures.

METHODS: We studied 248 consecutive open long-bone fractures in 237 patients over a 9-year period. The patients were followed until clinical or radiological union occurred or until a secondary procedure for non-union or infection was performed.

RESULTS: Surgical debridement was performed within 6h of injury in 62% of cases and after 6h in 38% of cases. Infection rates were 7.8% and 9.6%, respectively, and the difference was not statistically significant (p=0.6438). The timing of antibiotic administration was not significantly related to the infection rate.

CONCLUSION: Whilst open long-bone fractures should be treated expeditiously, we suggest that adherence to a 6h window has not been shown to affect infection rates nor has the timing of antibiotic administration during the acute phase.

Elsevier

Strategies in the treatment of infections with antibiotics in intensive care medicine.

Strategies in the treatment of infections with antibiotics in intensive care medicine.

Anasthesiol Intensivmed Notfallmed Schmerzther. 2007 Feb

Deja M,
Nachtigall I,
Halle E,
Kastrup M,
Guill MM,
Spies CD.

Abstract

The treatment of infections is one of the central elements in post-operative intensive care and contributes significantly to outcome. Measures of quality of antibiotic therapy include survival, duration of ICU or in-atient stay and rates of organ failure, antibiotic resistance or nosocomial infection. The pre-requisites for antibiotic prescribing in the intensive care unit are as follows: the treatment has to be started early, the antibiotic must be effective against probable causative organisms, the patient's risk factors for infection with multi-drug resistant organisms must be taken into account, local patterns of resistance must be known, an effective dosage must be used and the duration of therapy should be adjusted to the patient's risk factors and probable causative organisms. The multiplicity of factors which must be taken into account when determining timely empirical therapy and the fact that this must be possible at any time of the day, make local standard operating procedures for antibiotic prescribing imperative. These standards should reflect local resistance patterns and should be regularly reviewed. The aim of this educational article is to portray a selection of the pre-requisites and strategies available in the treatment of infections with antibiotics in intensive care medicine.

PMID: 17309018 [PubMed - as supplied by publisher]